We can not make any statements about the risk of thrombus from a
midline compared to the risk from a midclavicular (subclavian)
placement. The studies have compared midclavicular to SVC only.
If the therapy requires a central venous tip location due to the pH,
osmolarity, vesicant nature or any other factor, then you can not be
satisfied until you get the catheter into the SVC. Those caustic
therapies can not be infused through a midline catheter as a midline
and a central line are not interchangeable.
You need to obtain the AVA position paper on PICC tip location and
follow those recommendations about assessing the therapy, patient,
etc to determine if you should allow the catheter to remain in the
sub-optimal subclavian or innominate veins. Lynn
At 2:57 PM -0400 4/24/06, Lawler, Maureen C. wrote:
We occasionally have a situation with very unstable ICU patients where bedsde
attempted PICC placement is short, subclavian or inominate. We
understand these
are sub optimal placements and I have heard IV practitioners say
that you either
get it svc or you pull it back to midline. The chance of causing a thrombus
with midline placement is greater than with subclavian placement...correct?
This situation does not occur very often and we remedy as soon as
possible. If
we measured incorrectly we would exchange but if cath just won't progress any
further than subclavian wouldn't we be better off leaving it in the larger
vessel than pulling it back midline.
--
Lynn Hadaway, M.Ed., RNC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
http://www.hadawayassociates.com
office 770-358-7861
